Provider Demographics
NPI:1831474899
Name:HARVILL, LETA LORRAINE (BST)
Entity Type:Individual
Prefix:
First Name:LETA
Middle Name:LORRAINE
Last Name:HARVILL
Suffix:
Gender:F
Credentials:BST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 LANDMARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060
Mailing Address - Country:US
Mailing Address - Phone:775-209-2273
Mailing Address - Fax:
Practice Address - Street 1:1330 LANDMARK AVENUE
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060
Practice Address - Country:US
Practice Address - Phone:775-209-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner